Transpupillary Thermotherapy in the Treatment of Choroidal Metastasis from Breast Carcinoma

Vianna, Raul N. G.; Pena, R.; Muralha, Acácio; Muralha, Lília; Muranaka, Eduardo

doi:10.1023/b:inte.0000018525.92811.e4

Cited by 14 publications

(7 citation statements)

References 9 publications

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“…Common treatment options for symptomatic CM include systemic chemotherapy, EBRT and radioactive plaque therapy. In addition, transpupillary thermotherapy and photodynamic therapy have been proposed (Rudoler et al 1997;Shields et al 1997b;Vianna et al 2004;Mauget-Faysse et al 2006). The decision to treat CM depends on the extent of metastatic disease and is made in consultation with the oncologist (Bornfeld 2007).…”

Section: Discussionmentioning

confidence: 99%

Incidence and clinical characteristics of symptomatic choroidal metastasis from lung cancer

Kreusel

Bechrakis

Wiegel

et al. 2008

Acta Ophthalmologica

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ABSTRACT.Purpose: To determine the clinical characteristics of symptomatic choroidal metastasis (CM) resulting from metastatic lung cancer. Methods: Twenty-two consecutive patients with symptomatic CM resulting from lung cancer were retrospectively reviewed for ocular findings, medical history and systemic disease. All patients underwent a complete screening for further organ metastasis by computed tomography (CT) and bone scintigraphy. Annual frequency of CM was determined and compared with the incidence predicted from ocular screening studies. Results: In eight of 22 (36%; 95% confidence interval [CI] 17-59) patients, lung cancer had been diagnosed before occurrence of CM, with a median interval of 13 months. In 14 patients lung cancer was detected after diagnosis of CM, with a median interval of 1 month. Choroidal metastasis was unilateral, solitary and located close to or at the posterior pole in the majority of patients. Further organ metastasis with a median number of three affected organ systems was present in 19 (86%; 95% CI 65-97) patients. Median survival after diagnosis of symptomatic CM was 13 months, by contrast with 2 months in lung cancer patients with CM identified in an ocular screening study. The mean number of patients in Berlin diagnosed with symptomatic CM was 1.4 per year, which was two orders of magnitude less than predicted from screening studies. Conclusions: Symptomatic choroidal lung cancer metastasis in the majority of patients presents as a solitary tumour before diagnosis of lung cancer in patients with multiple organ systems affected by metastatic disease. Contrary to predictions from ocular screening studies, it is a rare clinical entity.

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Section: Discussionmentioning

confidence: 99%

Incidence and clinical characteristics of symptomatic choroidal metastasis from lung cancer

Kreusel

Bechrakis

Wiegel

et al. 2008

Acta Ophthalmologica

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“…[ 53 ] Expansion of the technique into other intraocular tumors has led to the treatment of choroidal metastases. [ 54 55 56 ] In a study of 59 eyes with choroidal metastasis managed with TTT as the primary treatment, 71% of eyes showed regression or inhibition of growth, while 7% showed progression over a follow-up period of 15 months. [ 54 ]…”

Section: Transpupillary Thermotherapymentioning

confidence: 99%

Choroidal metastases: Origin, features, and therapy

Arepalli¹,

Kaliki²,

Shields³

2015

Indian J Ophthalmol

141

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The choroid is the most common ocular site for metastatic disease, owing to abundant vascular supply. The primary cancers that most commonly lead to choroidal metastases include breast cancer (40-47%) and lung cancer (21-29%). Bilateral, multifocal metastases are most often secondary to breast cancer, whereas unilateral, unifocal metastasis are more commonly found with lung cancer. The treatment of choroidal metastasis depends on the systemic status of the patient and number, location, and laterality of the choroidal tumors. Treatment options include observation in patients with poor systemic status or those with resolved or asymptomatic disease; systemic chemotherapy, immunotherapy, hormone therapy, or whole eye radiotherapy if the metastases are active, multifocal and bilateral; plaque radiotherapy, transpupillary radiotherapy, or photodynamic therapy for active, solitary metastasis; and enucleation for those with blind painful eye. A database search was performed on PubMed, using the terms “choroidal metastasis,” or “choroidal metastases,” in combination with terms such as “treatment,” “features,” or “diagnosis.” Relevant articles were extracted and reviewed.

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“…Studies reporting systemic chemotherapy for uveal metastases were confined to small case series and case reports 10,12,13,21,33–42 . A smaller number of small case series and case reports described other treatment options such as brachytherapy, 10,43,44 proton beam therapy (PBT), 45 TTT, 46–49 PDT 50,51 and laser photocoagulation 10,52 . Two studies examined sequential radiotherapy followed by cytotoxic chemotherapy 12,29 .…”

Section: Resultsmentioning

confidence: 99%

“…Other treatment modalities described in the literature for the management of uveal metastases include brachytherapy, 13,43,44 PBT, 45 indocyanine green‐augmented TTT, 46–48 PDT 50,51 and laser photocoagulation 52 . These studies were confined to small case series and case reports and all therefore received level V evidence ratings (level D recommendation).…”

Section: Treatment Modalitiesmentioning

confidence: 99%

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Management of metastatic carcinoma of the uveal tract: an evidence‐based analysis

Kanthan

Jayamohan

Yip

et al. 2007

Clinical Exper Ophthalmology

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Uveal metastasis from carcinoma is the most common cause of ocular malignancy in adults and represents an increasing problem in the context of an ageing population and enhanced survival of stage IV cancer patients. The reported prevalence of clinically evident uveal metastases in carcinoma patients ranges from 2% to 9%, with breast and lung cancer together accounting for between 71% and 92% of cases. Most patients (66-97%) have a known history of cancer and, although the majority have metastatic lesions elsewhere, up to 33% may present with an isolated ocular metastasis. These lesions may progress rapidly and are potentially sight-threatening. Early diagnosis and appropriate timely treatment are therefore of paramount importance to maintain patients' quality of life. The diagnosis is usually clinical and detailed descriptions of symptomatology and physical characteristics are provided. In 21-50% of patients, involvement is bilateral. External beam radiotherapy (EBRT), chemotherapy, hormone and biological therapies, brachytherapy, transpupillary thermotherapy, laser photocoagulation/photodynamic therapy and enucleation are therapeutic modalities described in the literature for the management of uveal metastases. The strongest evidence favours timely EBRT for the management of sight-threatening uveal metastases. The published evidence supporting EBRT for sight-threatening uveal metastases was given a grade B (strong support for recommendation). Newer alternative therapies are emerging and may have a role in selected patients; however, there are unfortunately few large studies examining such treatments for carcinoma metastatic to the eye. The role of these modalities will be further clarified with the results of larger comparative trials.

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Transpupillary Thermotherapy in the Treatment of Choroidal Metastasis from Breast Carcinoma

Abstract: TTT can be considered an acceptable therapeutic option for solitary choroidal metastasis associated with serous retinal detachment.

Cited by 14 publications

References 9 publications

Incidence and clinical characteristics of symptomatic choroidal metastasis from lung cancer

Incidence and clinical characteristics of symptomatic choroidal metastasis from lung cancer

Choroidal metastases: Origin, features, and therapy

Management of metastatic carcinoma of the uveal tract: an evidence‐based analysis

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